Lesson of the month 2: A case of nitrous oxide-induced pancytopenia

An 18-year-old female patient presented to the emergency department with non-specific neurological and gastrointestinal symptoms and was found to be pancytopenic. Her vitamin B-12 level was low with a normal mean corpuscular volume and her full blood count 2 months previously had been within normal range. She reported heavy use of nitrous oxide over the previous 2 weeks and other investigations revealed no cause for her pancytopenia. Her pancytopenia resolved with discontinuation of nitrous oxide and vitamin B-12 treatment. Heavy use of nitrous oxide should be considered as a cause of pancytopenia.